Appointments - Alzheimer's Resource of Alaska

Request a Screening or Consultation

If you are having a medical emergency, call 911 for emergency medical help.

Complete the form below to request an in-person appointment or telephone consultation. A representative will contact you within two business days to assist you. We have offices in Anchorage, Fairbanks, and Wasilla.

Dementia Education Specialist ConsultationCare Coordination ConsultationMemory Screening

If you are human, leave this field blank.

At which Care Coordination of Alaska location are you requesting an appointment?

Anchorage, Alaska

Mat-Su, Alaska

Please choose one location for the appointment

Contact Information

First Name

Last Name

Gender

Male

Female

Have you previously received services or contacted the Care Coordination of Alaska?

Yes

I don't know

Address

Apt, suite, etc.

Country

City

State

Zip code

Primary Phone

Secondary Phone

Your Email

Requester Information

Who are you requesting this appointment for?

Self

Other

If "other", what is the name of care recipient?

Reason why you are scheduling an appointment:

I need a Care Coordinator

I have general questions about care coordination

Other

Please select at least one reason.

If other, please provide reason.

Have you applied for the State of Alaska Home and Community Based Waiver Program?

Yes

Unsure

If you would like to provide additional information to the appointment staff, please add it here:

If you have any trouble with the form above please call us at 907-561-3313 to schedule an in-person appointment or telephone consultation.